Comparison of three methods for diabetes screening in a rural clinic in Honduras

Objective. To evaluate two alternatives to the fasting plasma glucose (FPG) test for diabetes screening in Latin America. Methods. Eight hundred adults without diabetes were recruited in a primary care clinic in Honduras. An equation-based screening formula, incorporating a random capillary glucose test and other risk factors, was used for initial screening. All patients with a screening-based probability of diabetes > 20%, plus one-fifth of those with a probability < 20%, were asked to return for FPG and point-of-care hemoglobin A1c (POC-A1c) tests. An FPG ≥ 126 milligrams per deciliter and a POC-A1c ≥ 6.5% were used as gold standards to assess the performance of the screening equation. The association between the POC-A1c and the FPG tests was examined as were patient factors associated with failure to return for follow-up and variation in diabetes risk across subgroups. Results. The screening equation had excellent test characteristics compared with FPG and POC-A1c. Using the FPG gold standard, the POC-A1c had a sensitivity of 77.8% and a specificity of 84.9%. With an A1c cutoff of 7%, POC-A1c specificity increased to 96.2%. Thirty-four percent of patients asked to return for follow-up testing failed to do so. Those who failed to return were more likely to be men and to have hypertension. Conclusions. Both the screening equation and POC-A1c are reasonable alternatives to an FPG test for identifying patients with diabetes. Given the barriers to currently recommended screening procedures, these options could have important public health benefits in Latin America

Formation of extended topological defects during symmetry breaking phase transitions in O(2) and O(3) models

The density of extended topological defects created during symmetry-breaking phase transitions depends on the ratio between the correlation length in the symmetric phase near $T_c$ and the winding length of the defects as determined by the momentaneous effective action after a typical relaxation time. Conservation of winding number in numerical simulations requires a suitable embedding of the field variables and the appropriate geometrical implementation of the winding density on the discrete lattice. We define a modified Kibble limit for the square lattice and obtain defect densities as functions of winding lengths in O(2) and O(3) models. The latter allows to observe formation of disoriented aligned domains within the easy plane. Their extent is severely limited by the momentaneous defect density during the course of the quench.Comment: 16 pages, 9 figure

Mobile Graphic-based Communication: Investigating Reminder Notifications to Support Tuberculosis Treatment in Africa

Visual communication is a method of communication using visual elements, which is suggested to be more effective than text or voice, and has the additional advantage that it, can also be used by who are unable to read. In this paper, the findings of a user requirements study, which was conducted at MnaziMmoja Hospital in Zanzibar, are presented. In a cross-sectional study, twenty nine people including TB patients and TB Health care workers were interviewed. The findings show that participants agreed that the use of mobile graphic-based communications could support TB patients in their treatment. The contribution of this work is the process to investigate and develop a new mobile graphic-based application for push notification services that are literacy-level and language agnostic

Text Messaging for Disease Monitoring in Childhood Nephrotic Syndrome

Introduction: There is limited information on effective disease monitoring for prompt interventions in childhood nephrotic syndrome. We examined the feasibility and effectiveness of a novel text messaging system (SMS) for disease monitoring in a multicenter, prospective study. Methods: A total of 127 patients <19 years with incident nephrotic syndrome were enrolled in the ongoing Nephrotic Syndrome Study Network between June 2015 and March 2018. Text messages soliciting home urine protein results, symptoms, and medication adherence were sent to a designated caregiver (n = 116) or adolescent patient (n = 3). Participants responded by texting. Feasibility of SMS was assessed by SMS adoption, retention, and engagement, and concordance between participant-reported results and laboratory/clinician assessments. The number of disease relapses and time-to-remission data captured by SMS were compared with data collected by conventional visits. Results: A total of 119 of 127 (94%) patients agreed to SMS monitoring. Retention rate was 94%, with a median follow-up of 360 days (interquartile range [IQR] 353–362). Overall engagement was high, with a median response rate of 87% (IQR, 68–97). Concordance between SMS-captured home urine protein results and edema status with same-day in-person study visit was excellent (kappa values 0.88 and 0.92, respectively). SMS detected a total of 108 relapse events compared with 41 events captured by scheduled visits. Median time to remission after enrollment was 22 days as captured by SMS versus 50 days as captured by scheduled visits. Conclusion: SMS was well accepted by caregivers and adolescent patients and reliably captured nephrotic syndrome disease activity between clinic visits. Additional studies are needed to explore the impact of SMS on disease outcomes